Clinical and morphological rationale for selecting endovideolaparoscopic appendectomy tactics for acute appendicitis and its complications

Relevance. Acute appendicitis (AA) remains the leading cause of emergency surgical interventions, while the high frequency of complicated forms requires improvement of diagnostic and therapeutic approaches. Endovideolaparoscopic appendectomy (EVLA) demonstrates the potential to reduce the surgical injury and improve prognosis. Purpose. To develop a stratified algorithm for choosing laparoscopic appendectomy tactics based on clinical and morphological analysis in order to reduce intraoperative risks, prevent complications, and decrease the rehabilitation period for all forms of AA, including peritonitis. Materials and methods. A retrospective analysis of 182 cases of EVLA was performed in Almozn Hospital (Libya, 2019–2024). Of these, 128 patients with complete clinical, instrumental, and histological data were analyzed. Diagnostics included laboratory parameters, ultrasound, MSCT, and intraoperative laparoscopy. Results. The developed algorithm ensured high diagnostic accuracy (EVL – 96%, ultrasound – 87.6%), a decrease in overdiagnosis by 31.5%, the frequency of laparotomies by 41.5%, and postoperative complications to 4.7%. The average duration of hospitalization was 3.2±0.8 days. Conclusion. The introduction of modern clinical algorithms in the diagnosis and treatment of acute appendicitis increases the accuracy of pathology verification, reduces the need for traumatic laparotomies, and minimizes intraoperative complications. Intraoperative laparoscopy provides an objective assessment of the stage of appendix destruction, allowing personalization of surgical tactics and improvement of the treatment prognosis.